RN Utilization Review Specialist — Case Management Lead

Methodist Hospital for Surgery; Addison (TX); Hybrid; USD 70,000 - 90,000; Full time

Job summary

Methodist Hospital for Surgery in Addison, TX is seeking an RN Utilization Review Coordinator in the Case Management department. The role performs prospective, concurrent, and post-discharge reviews to ensure medical necessity and regulatory compliance.

You will collaborate with physicians, nurses, and payers, support discharge planning, and contribute to quarterly utilization reports and quality initiatives. A Texas RN license and 5+ years of relevant experience are expected.

Qualifications

• RN with Texas license and current CPR certification.
• Minimum five years in Case Management, Discharge Planning and Utilization Review.
• Case Management Certification preferred.
• Strong collaboration and communication with physicians and care team.

Responsibilities

• Perform prospective, concurrent, and post-discharge utilization reviews to verify medical necessity.
• Determine admission status and assist with discharge planning.
• Generate denial management and appeals with appropriate documentation.
• Contribute to regulatory compliance and quality improvement initiatives.

Education

Bachelor of Science in Nursing

Case Management Certification(s) preferred

Job description

Methodist Hospital for Surgery in Addison, TX is seeking an RN Utilization Review Coordinator in the Case Management department. The role performs prospective, concurrent, and post-discharge reviews to ensure medical necessity and regulatory compliance.

You will collaborate with physicians, nurses, and payers, support discharge planning, and contribute to quarterly utilization reports and quality initiatives. A Texas RN license and 5+ years of relevant experience are expected.